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The field of medicine is growing and expanding so that those that have chosen the profession now have an incredible array of choices and options. Unlike the past, where a physician was limited to only an independent practice or one within a hospital or clinic setting, doctors have an incredible selection of practice types that can assist their personal and professional goals. The additional benefit of our time is that a choice doesn’t have to be lifelong, there are many doctors that change their directions based on their personal preferences.
With the onset of the COVID-19 pandemic, the medical industry is experiencing some complete changes in the methodologies that have been established. Protection of patients and staff has led to alterations in the way that physicians see and treat patients with the foremost change being the use of more telehealth instead of in-house visits. Just as the internet has altered the way we work, play, pay, and see the world, so may COVID-19 bring changes that we didn’t anticipate. It will remain to be seen if this alters medical practices in the future once the pandemic is under control.
While the definition of “solo” is “done by one person alone; unaccompanied,” it is a bit misleading when referring to a solo practice, as we know that a physician never operates completely alone. What it does relate to is a physician’s office that is completely owned by one individual, without partners or any practice organizations or other people of influence. Physicians that want to retain and promote their autonomy prefer solo practices. They like to be part of the community and be well-known as a physician in the area. The autonomy offers them the opportunities for patient referrals to grow their company.
Solo practices were once the norm in the United States, with the local country doctor taking care of an entire community. Once the advent of larger medical institutions took hold there were fewer solo practices as patients could go to one healthcare organization to be treated by many specialists. Solo practices are again picking up popularity as patients are seeking more personal care. This is especially true during the COVID-19 pandemic where physicians are making use of more telehealth contact with their patients.
The solo practice involves a single physician that is responsible for all of the practice. The physician makes decisions and creates policies for office hours, technologies used, finances, hours of operation, staffing, legal aspects, and creating compliance guidelines.
The solo practice typically has a smaller staff as well as reduced patient base. In this environment a physician can develop a closer-knit relationship with patients, providing a unique style of treatment and a level of trust. Solo practices have the ability to choose to remain small or adapt and grow as needed.
The downside to a solo practice is that one physician is responsible for all aspects of running the practice. This level of responsibility can entail everything from managing/arranging weekend or hospital care for patients, the business side of the organization, compliance all local, state and federal guidelines; hiring employees, technology decisions, ensuring the safety of staff, developing agreements with insurers, complying with all documentation, having staff coverage due to illness or vacation, making sure of malpractice coverage, and any and all emergency condition that may arise.
As the demand for specialty medical services has expanded there has been in increase in group practices. There are multiple levels of benefits for group practices has they share in a variety of the responsibilities. A group practice can be a multispecialty or single-specialty practice, and typically has two or more physicians on staff that supply patients with specific care types. Multispecialty practices have a variety of healthcare within a single organization and single-specialty offers a specific type of care with primary care and secondary care specialists.
Group practices offer advantages for both patients and physicians. Patients still have the ability to get the kind of attention that they might within a solo practice which encourages health compliance, while physicians have enhanced financial security with the availability of multiple physicians taking responsibility.
A group practice is typically larger with a more extended patient base. This can be an advantage for employees as they can offer staff more benefits. With a bigger staff a group practice has assigned individuals for many of the priority responsibilities such as business manager, an IT Department, a billing/insurance specialist, and those knowledgeable of local, state, and federal laws and guidelines needed for compliance. The added number of physicians on staff spreads out the burden of critical patient care for nights, weekends, holidays, and hospital, allowing a more flexible schedule for everyone involved.
The downside of a group practice is the same with any group of people: the potential for differences of opinion or conflict. Unlike the smaller solo practice, a group practice will lean more towards policy driven and management governed which some may view as the same as a larger medical environment.
Also called “integrated delivery systems,” there are a few models for employed physician practices. Some choose to be employed in a single practice such as a hospital or HMO, while others select to work with a healthcare corporation that may operate a variety of clinics or locations such as inpatient facilities or nursing homes/extended care. There are also additional options that include physician-run groups that use a structure that employs physicians as clinicians instead of having the usual group practice model. In this environment, a physician can retain his/her autonomy as they become known and familiar in the various settings.
An employed physician can make choices as to where he or she wishes to work while eliminating all of the intense responsibilities of solo or group practices. Their focus can be on treating patients without the hassles of the day-to-day operations of the business. An additional benefit is that an employed physician has an excellent compensation, while also having an increase in the support services needed to practice medicine.
The downside to the employed physician practice is that they are typically hired by larger organizations that have a higher demand on their time. Scheduling in the physician hired model may be erratic and based on need. Employed physicians have to have a flexible schedule that meets the expectations and needs of the organization. The employed physician is considered to be an employee and may also have to participate in company activities as well as requested to serve on committees that benefit the community and give the organization an improved standing.
An HMO (health maintenance organization) provides healthcare for their beneficiaries and members with a goal to reduce medical costs. While there are various HMO models, including staff and group HMOs, the benefit of working for an HMO includes stability in working regular hours. Physicians that work for HMOs experience the same advantages of other physician employed opportunities. HMO physicians have the potential for opportunities for bonuses based on patient feedback. Most HMOs offer physicians an excellent income, the ability to share flexibility for emergency/non-standard hours, and a focus on patient treatment with a good support staff.
The downside to physician employment at large HMOs is that they are required to comply with corporate guidelines, many of which limit the amount of time spent with or devoted to the patient, no matter how ill. The reason for this returns to the goal of lower medical costs. Many of the HMOs have a business model that includes having a physician see/treat as many patients as possible within the work day, and this approach may not be one that some physicians prefer. Physicians employed by an HMO may not be happy with their lack of autonomy. In this environment they are often just “another doctor” with little recognition.
Physicians employed by hospitals typically have a good referral network, a regular patient base, and their income is solid and predictable. Physicians employed by a hospital will either work in a practice owned by the hospital or a hospital department. The physicians benefit from a full support staff with departments that handle all of the legalities and business work. They are free to focus on patient treatment and follow-up and often work in conjunction with a patient’s other medical teams to coordinate post-hospital follow-ups, medication, and medication compliance. The hospital employed physician is viewed as an employee and is required to comply with all guidelines and rules of the hospital. These guidelines can be viewed as restrictive or corporate-style and may not be attractive to some physician styles.
The downside for a physician employed at a hospital is the lack of autonomy and the fact that they may be required to be part of hospital committees.
The independent contractor model for either solo or group practice has been of great benefit for some internists. The physician retains their independence, however, the facility is often shared with other physician groups or physicians. The benefit allows the financial costs of a practice to be spread out and shared as well as the potential of clinical schedule flexibility.
While they don’t have the responsibilities of day to day business operations a downside is that the independent contractor also lacks any way to participate in decision making. Depending upon the outlook, this can be either a benefit or a downside.
This is an alternative type of physician employment that offers opportunities to a location from a few weeks all the way to a full year. Locum tenens are both offered by and popular with practices, healthcare organizations, and hospitals. In their case, they have a clinical need that requires fulfillment, but it may not be permanent. In a majority of cases those working in Locum tenens have compensation that is higher than the average position in the same facility that would be full time. Working temporarily gives a physician the chance to be in a variety of locations and facility types for various lengths of time without the long-term employment commitment.
The downside to this would be any physician that requires more stability. Due to the constant relocation, it may not be the right choice for anyone with a family that is uncomfortable with uprooting them every so many months.
Including this as a new option due to the fact that the COVID-19 pandemic has now altered the way that physicians treat and talk to their patients. As hospitals fill up with COVID-19 patients they are restricting standard patient visits. Clinics, solo, and group physician locations are setting up a triage aspect to see only those with the most severe illnesses or injuries and instead making use of telehealth phone calls or Zoom/Facetime calls to other patients.
Telehealth had been previously slow to take off as patients seemed to prefer in-person visits with their doctors. However, the benefit of telehealth conference calls is that the doctor can focus on the needs of the patients, check to make sure they are taking their medications, prescribe new/altered medications, and share the same care and concern that they might have in an office environment. Physicians are using telehealth for follow-up visits which enables another touchpoint to make sure that patients are being proactive with their healthcare needs.
One of the biggest challenges for physicians has always been patient appointments. Many miss or reschedule their appointments and this can have an effect on their healthcare. An Updox survey has shown that 65% of the respondents have indicated that telehealth visits are more convenient and 63% state that they like not having to be concerned about being in a medical area that may expose them to sick patients. 44% in the survey have said they think making a telehealth appointment is easier and 33% have said they like the way communication and follow-ups are streamlined after the appointment.
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